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Objective: To show the potential role of N-acetylcysteine in the treatment of novel H1N1 influenza pneumonia in a dose used to treat acetaminophen overdose.

Case Report: On 15 July 2009, we admitted a previously healthy woman to the intensive care unit in a Hong Kong hospital for novel H1N1 human swine influenza (H1N1) pneumonia with septic shock and type 1 respiratory failure. She was 48 years of age, was not obese, and was a long-term smoker. She required pressure-controlled ventilation with 100% oxygen, 18-cm H2O positive end-expiratory pressure, and inhaled nitric oxide at 20 ppm to maintain blood oxygen saturation above 90%. We started treatment with norepinephrine infusion and physiologic doses of hydrocortisone for septic shock. Test results for bacterial co-infection were negative.